Provider Demographics
NPI:1114726429
Name:MEDICAL ELECTRODIAGNOSTICS & IMAGING INC
Entity type:Organization
Organization Name:MEDICAL ELECTRODIAGNOSTICS & IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-436-4627
Mailing Address - Street 1:13160 MINDANAO WAY STE 310
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7907
Mailing Address - Country:US
Mailing Address - Phone:877-436-4627
Mailing Address - Fax:
Practice Address - Street 1:13160 MINDANAO WAY STE 310
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-7907
Practice Address - Country:US
Practice Address - Phone:877-436-4627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty